Author: Abbas Tayyab Syed, Mohsin Tahir / Editor: Sarah Edwards / Codes: / Published: 13/10/2025
A 72-year-old female presents to the Emergency Department (ED) with a 3-hour history of left-sided numbness affecting her face, arm and leg. She has no slurred speech, facial droop or limb weakness.
The patients vital signs are stable, including a blood pressure of 135/80 mm/Hg, pulse of 82 bpm, temperature of 36.8 C, and respiratory rate of 18 breaths per minute.
On Examination, neurological examination including her cranial nerves, motor power, tone, and reflexes were intact. Gait, eye movements, and speech were unremarkable, and the rest of the systemic examination is also grossly normal Routine blood tests are normal limits.
Past Medical and Medication History:
Type 2 diabetes mellitus, hypertension, and hyperthyroidism. She was recently diagnosed with AF and prescribed Apixaban, a direct oral anticoagulant (DOAC), one month ago, please note, that she admitted to poor compliance with Apixaban therapy, having taken it only for two to three days and discontinued without informing her General Practitioner or Cardiologist. Other medications included bisoprolol, Olmesartan, spironolactone, Eltroxin, and insulin (Tresiba and NoVo Rapid).
Given the symptoms, an initial CT brain was performed, revealing an acute infarct in the right posterior cerebral artery (PCA) territory, likely due to a distal P1 segment occlusion. MRI confirmed this finding.
The patient is admitted to the stroke unit, where she received stroke protocol care, including anticoagulation reinstatement, blood pressure control, glycaemic management, physiotherapy, speech and language therapy, and occupational therapy, were consulted. By the end of her 10-day stay, her functional mobility had significantly improved, and she was discharged.
